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Ketamine Use Among Regular Tobacco and Alcohol Users As Revealed by Respondent-Driven Sampling in Taipei: Prevalence, Expectancy, and Users’ Risky Decision Making

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Ketamine Use Among Regular Tobacco and Alcohol Users As Revealed by Respondent-Driven Sampling in Taipei: Prevalence, Expectancy, and Users’ Risky Decision Making journal of food and drug analysis 21 (2013) s102es105 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.jfda-online.com Ketamine use among regular tobacco and alcohol users as revealed by respondent-driven sampling in Taipei: Prevalence, expectancy, and users’ risky decision making Wei J. Chen a,b,c,*, Te-Tien Ting a,d, Chao-Ming Chang a, Ying-Chun Liu a, Chuan-Yu Chen b,d,e a Institute of Epidemiology and Preventive Medicine, College of Public Health, Taipei, Taiwan, ROC b Department of Public Health, College of Public Health, Taipei, Taiwan, ROC c Department of Psychiatry, College of Medicine and National Taiwan University Hospital, Taipei, Taiwan, ROC d Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan, ROC e Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC abstract Keywords: The popularity of ketamine for recreational use among young people began to increase, Decision making particularly in Asia, in 2000. To gain more knowledge about the use of ketamine among Expectancy high-risk individuals, a respondent-driven sampling (RDS) was implemented among reg- Ketamine ular alcohol and tobacco users in the Taipei metropolitan area from 2007 to 2010. The Respondent-driven sampling (RDS) sampling was initiated in three different settings (i.e., 2 in the community and 1 in a clinic) to recruit seed individuals. Each participant was asked to refer one to five friends known to be regular tobacco smokers and alcohol drinkers to participate in the present study. In- centives were offered differentially upon the completion of an interview and successful referral. Information pertaining to drug use experience was collected by an audio computer-assisted self-interview instrument. Software built for RDS analyses was used for data analyses. Of the 1,115 participants recruited, about 11.7% of the RDS respondents reported ever having used ketamine. Positive expectancy of ketamine use was positively associated with ketamine use; by contrast, negative expectancy was inversely associated with ketamine use. Decision-making characteristics as measured on the Iowa Gambling Task (IGT) using reinforcement learning models revealed that ketamine users learned less from the most recent event than both tobacco- and drug-naı¨ve controls and regular to- bacco and alcohol users. These findings about ketamine use among young people have implications for its prevention and intervention. Copyright ª 2013, Food and Drug Administration, Taiwan. Published by Elsevier Taiwan LLC. All rights reserved. * Corresponding author. Institute of Epidemiology and Preventive Medicine, College of Public Health, 17 Xu-Zhou Road, Taipei 100, Taiwan, ROC. E-mail address: [email protected] (W.J. Chen). 1021-9498/$ e see front matter Copyright ª 2013, Food and Drug Administration, Taiwan. Published by Elsevier Taiwan LLC. All rights reserved. http://dx.doi.org/10.1016/j.jfda.2013.09.044 journal of food and drug analysis 21 (2013) s102es105 S103 Based on these prevalence data, ketamine seemed to be 1. Increasing popularity of ketamine use becoming more popular within adolescent drug culture, among young people particularly among middle school students, during the study period of 2004e2006. This switching of popularity between ec- Ketamine was initially used for war injuries in the early 1970s stasy and ketamine might be attributed to the harsher regula- [1], and became a club drug in the 1990s [2]. Since 2000, the tions on the use of ecstasy (with offenders being incarcerated popularity of ketamine for recreational use among young for enforced detoxification and drug education) compared with people began to increase [3], particularly in Asia [4]. The con- that of ketamine (no incarceration for offenders) in Taiwan. sumption of ketamine can lead to a variety of health prob- lems, such as cognition impairment, kidney dysfunction, and accidental deaths [2,5], and may result in even more severe health problems if used with other drugs simultaneously or in 2. Using respondent-driven sampling to sequence [6,7]. reach high-risk individuals The culture of illegal drug or inhalant use among young people in Taiwan underwent a major change in the past two Because illegal drug users are often clustered or connected in decades. In national surveys from 1991 through to 1996 among social networks, researchers have developed respondent- adolescent students aged 13e18 years in Taiwan, the preva- driven sampling (RDS) to explore this hidden population lence of any illegal drug or inhalant use ranged from 1.1% to via probability-theoretical methods to compensate for e 1.5%, with the most commonly consumed illegal drugs or in- nonrandom sampling [12 15]. Starting in 2008, a series of RDS halants being methamphetamine, glue sniffing, and fluni- implementations was undertaken in Taiwan, where the trazepam [8]. However, later surveys in the 2000s indicated that stigma against illegal drug use remains strong and severe club drugs, which mainly consisted of ecstasy, ketamine, and punishment is stipulated by law [16,17]. The RDS was carried marijuana, had emerged as the most commonly consumed out among regular tobacco and alcohol users in the Taipei e illegal drugs among young people in Taiwan [9,10]. metropolitan area in 2008 2010. Through regular tobacco and Early epidemiological evidence of the increasing popularity alcohol users, who were shown to have an elevated risk of of ketamine in Taiwan was from a pilot outreach study. In a illegal drug use [10], the RDS procedures efficiently reached survey via a street outreach program among 2,126 adolescents the subpopulation of illegal drug users. The recruitment aged 12e18 years recruited from Taipei street sites in 2002, criteria and implementation of the RDS have been described ketamine was found to be the second most commonly in detail elsewhere (Ting T-T, Chen C-Y, Tsai Y-S, et al, un- consumed illegal drug for adolescents with truancy, with published data). Briefly, every seed was asked to recruit one to 12.1e14.5% reporting ecstasy use, 4.6e7.3% reporting keta- five friends who were regular tobacco and alcohol users and e mine use, and 3.5e8.8% reporting marijuana use, whereas the were 18 40 years old. When their peers were introduced to corresponding estimate was 3.1e3.4% for youths without this study, these newly recruited individuals were also asked truancy [9]. Later, more extensive, nationwide outreach pro- to refer their peers. Incentives were offered differentially upon grams across 26 cities/towns in Taiwan were conducted in the the completion of an interview and successful referral. period from 2004 to 2006 with a total of 18,420 participants Prior to beginning an interview, the interviewers took the aged 12e18 years. For those who were living with their fam- respondent to a private place to provide informed consent ilies but reported to have experience of running away from using a nickname. The participants were reassured that their home (n ¼ 1626), ketamine (n ¼ 75, 4.6%) was again found to be information was strictly confidential and that they only the second most common illegal drug ever used, next to ec- needed to give their nickname, the last four digits of a 10-digit stasy (n ¼ 139, 8.5%) [11]. national identification number, and a cell phone number for The popularity of ketamine as a recreational drug was the researchers to follow up with them annually via the further confirmed in national surveys among school-attending Internet. Each participant underwent an audio computer- adolescents in Grades 7, 9, 10, and 12, aged 11e19 years, in assisted self-interview regarding their experience with drug 2004e2006 [10]. Ecstasy and ketamine, by and large, remained use, the expectancy of ketamine use, and other measure- the most and second most commonly used illegal drugs, ments. All of the information provided by the respondents respectively, during the 3-year period for both middle and high was used only for data linkage and the creation of individual school students [10]. For middle school students, the preva- accounts for their questionnaires and neuropsychological lence of ecstasy use was 0.28%, 0.25%, and 0.07% in 2004, 2005, tests, including the Iowa Gambling Task (IGT) [18]. This RDS and 2006, respectively, and the corresponding figure for keta- sample thus provided a group of ketamine users whose mine was 0.15%, 0.18% and 0.15% in 2004, 2005, and 2006, network of relationships were known and can thus be sub- respectively. For high school students, the prevalence of ec- jected to estimation using social network-based methods. stasy use was 1.72%, 0.82%, and 0.52% in 2004, 2005, and 2006, respectively, and the prevalence for ketamine was 1.13%, 0.61%, and 0.44% in 2004, 2005, and 2006, respectively. Among 3. Ketamine becoming the most commonly ecstasy users, ketamine (41.4e53.5%) was the most common consumed illegal drug in the RDS sample other drug used; meanwhile, ketamine continued to be initi- ated almost exclusively at the same age as ecstasy. Neverthe- During the 3-year period from 2008 to 2010, 1,115 individuals less, the proportion of ecstasy-naı¨ve ketamine users increased were successfully recruited via RDS. Population prevalences slightly but significantly from 0% in 2004 to 5.3% in 2006. adjusted for RDS (i.e., an estimate using both transition S104 journal of food and drug analysis 21 (2013) s102es105 probability and the network weighting system) were estimated sexual behaviors [23], they may have deficient decision- using the RDS Analysis Tool (RDSAT) [15] and their standard making skills that can be measured using a psychological errors were estimated using the bootstrapping method. task such as the IGT, which was originally developed to The results indicated that the weighted prevalence of examine decision-making deficits in patients with prefrontal lifetime use of three club drugs were 11.7% for ketamine, cortex damage [18,24].
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